Provider Demographics
NPI:1326027376
Name:KORKOR, KHALIL B (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:B
Last Name:KORKOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4736 ARMANDALE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2279
Mailing Address - Country:US
Mailing Address - Phone:330-966-7762
Mailing Address - Fax:
Practice Address - Street 1:4124 MUNSON ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2979
Practice Address - Country:US
Practice Address - Phone:330-492-6662
Practice Address - Fax:330-492-6918
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046973207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341712626027OtherCARESOURCE
OHP52523509OtherMULTIPLAN
OH0559819Medicaid
OH000000137194OtherANTHEM
OH341712626002OtherCHAMPUS
OHA81254Medicare UPIN
OH341712626027OtherCARESOURCE